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The Limited Clinical Utility of Testosterone, Estradiol, and Sex Hormone Binding Globulin Measurements in the Prediction of Fracture Risk and Bone Loss in Older Men
Oregon Hlth & Sci Univ, Sch Med, Bone & Mineral Unit, Div Endocrinol Diabet & Clin Nutr, 3181 SW Sam Jackson Pk Rd CR 113, Portland, OR 97201 USA..
Oregon Hlth & Sci Univ, Div Biostat, Dept Publ Hlth & Prevent Med, Portland, OR 97201 USA..
Oregon Hlth & Sci Univ, Sch Med, Bone & Mineral Unit, Div Endocrinol Diabet & Clin Nutr, 3181 SW Sam Jackson Pk Rd CR 113, Portland, OR 97201 USA..
Univ Gothenburg, Sahlgrenska Acad, Inst Med, Ctr Bone & Arthrit Res, Gothenburg, Sweden..
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2017 (English)In: Journal of Bone and Mineral Research, ISSN 0884-0431, E-ISSN 1523-4681, Vol. 32, no 3, p. 633-640Article in journal (Refereed) Published
Abstract [en]

Measurement of serum testosterone (T) levels is recommended in the evaluation of osteoporosis in older men and estradiol (E2) and sex hormone binding globulin (SHBG) levels are associated with the rate of bone loss and fractures, but the clinical utility of sex steroid and SHBG measurements for the evaluation of osteoporosis in men has not been examined. To evaluate whether measurements of T, E2, and/or SHBG are useful for the prediction of fracture risk or the rate of bone loss in older men, we analyzed longitudinal data from 5487 community-based men participating in the Osteoporotic Fractures in Men (MrOS) study in the United States, Sweden, and Hong Kong. Serum T, E2, and SHBG levels were assessed at baseline; incident fractures were self-reported at 4-month intervals with radiographic verification (US), or ascertained via national health records (Sweden, Hong Kong). Rate of bone loss was assessed by serial measures of hip bone mineral density (BMD). We used receiver operating characteristic (ROC) curves, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) to assess improvement in prediction. Mean age at baseline was 72 to 75 years and the prevalence of low T levels (<300 ng/dL) was 7.6% to 21.3% in the three cohorts. There were 619 incident major osteoporotic and 266 hip fractures during follow-up of approximately 10 years. Based on ROC curves, there were no improvements in fracture risk discrimination for any biochemical measure when added to models, including the Fracture Risk Assessment Tool (FRAX) with BMD. Although minor improvements in NRI were observed for the dichotomous parameters low bioavailable E2 (BioE2) (<11.4 pg/mL) and high SHBG(>59.1 nM), neither sex steroids nor SHBG provided clinically useful improvement in fracture risk discrimination. Similarly, they did not contribute to the prediction of BMD change. In conclusion, there is limited clinical utility of serum E2, T, and SHBG measures for the evaluation of osteoporosis risk in elderly men.

Place, publisher, year, edition, pages
WILEY , 2017. Vol. 32, no 3, p. 633-640
Keywords [en]
Fracture Risk Assessment, Osteoporosis, Aging, Epidemiology, Dxa
National Category
Endocrinology and Diabetes Nutrition and Dietetics
Identifiers
URN: urn:nbn:se:uu:diva-320853DOI: 10.1002/jbmr.3021ISI: 000398055900023PubMedID: 27753150OAI: oai:DiVA.org:uu-320853DiVA, id: diva2:1091347
Funder
NIH (National Institute of Health), U01 AG027810 U01 AG042124 U01 AG042139 U01 AG042140 U01 AG042143 U01 AG042145 U01 AG042168 U01 AR066160 UL1 TR000128Swedish Research CouncilSwedish Foundation for Strategic Research Torsten Söderbergs stiftelseNovo NordiskAvailable from: 2017-04-26 Created: 2017-04-26 Last updated: 2017-04-26Bibliographically approved

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Ljunggren, ÖstenKindmark, Andreas

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